Abstract：
OBJECTIVE: To compare the clinical efficacy and complication rates between the medial midline and anterolateral portals in ankle arthroscopy for treating medial osteochondral lesions of the talus (OLTs).
METHODS: We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients.
RESULTS: There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0 years, and the mean follow-up duration was 18.7 ± 6.4 months. The clinical outcomes improved significantly in both groups (*P < 0.05), but there was no significant difference between the two groups (P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups (P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group.
CONCLUSIONS: The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs.
METHODS: We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients.
RESULTS: There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0 years, and the mean follow-up duration was 18.7 ± 6.4 months. The clinical outcomes improved significantly in both groups (*P < 0.05), but there was no significant difference between the two groups (P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups (P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group.
CONCLUSIONS: The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs.
摘要：
目的：比较踝关节镜治疗距骨内侧骨软骨损伤（OLTs）的临床疗效和并发症发生率。
方法：我们回顾性分析了在2017年6月至2023年1月期间接受双内侧入路（通过内侧中线和前内侧门静脉）或传统入路（通过前内侧和前内侧门静脉）的内侧OLT患者。通过X光片评估损伤程度，计算机断层扫描,和磁共振成像。使用视觉模拟量表（VAS）评估临床结果，美国骨科足踝协会（AOFAS）评分，软骨修复组织（MOCART）评分系统的磁共振观察。术后并发症的发生率，包括腓浅神经（SPN）损伤，在所有患者中进行评估。
结果：共39例，16例患者行双内侧入路，23例患者接受了传统方法。平均年龄39.4±9.0岁,平均随访时间为18.7±6.4个月。两组患者的临床结局均有显著改善(*P<0.05),但两组间差异无统计学意义(P>0.05)。术后并发症主要为SPN损伤。SPN损伤的发生率在传统入路组为13.0%,在双内侧入路组为0%,两组间无显著性差异(P>0.05),但是在双内侧入路组中观察到SPN损伤减少的趋势。
结论：双内侧入路也可以很好地治疗内侧OLT，与传统方法相比，提供了清晰的可视化和更方便的操作，降低了SPN损伤的可能性。因此,我们认为MM门户在治疗内侧OLT方面将是前外侧门户的良好替代方法。
方法：我们回顾性分析了在2017年6月至2023年1月期间接受双内侧入路（通过内侧中线和前内侧门静脉）或传统入路（通过前内侧和前内侧门静脉）的内侧OLT患者。通过X光片评估损伤程度，计算机断层扫描,和磁共振成像。使用视觉模拟量表（VAS）评估临床结果，美国骨科足踝协会（AOFAS）评分，软骨修复组织（MOCART）评分系统的磁共振观察。术后并发症的发生率，包括腓浅神经（SPN）损伤，在所有患者中进行评估。
结果：共39例，16例患者行双内侧入路，23例患者接受了传统方法。平均年龄39.4±9.0岁,平均随访时间为18.7±6.4个月。两组患者的临床结局均有显著改善(*P<0.05),但两组间差异无统计学意义(P>0.05)。术后并发症主要为SPN损伤。SPN损伤的发生率在传统入路组为13.0%,在双内侧入路组为0%,两组间无显著性差异(P>0.05),但是在双内侧入路组中观察到SPN损伤减少的趋势。
结论：双内侧入路也可以很好地治疗内侧OLT，与传统方法相比，提供了清晰的可视化和更方便的操作，降低了SPN损伤的可能性。因此,我们认为MM门户在治疗内侧OLT方面将是前外侧门户的良好替代方法。
